Conclusions: The prominent associations among early oral- and manual-motor skills and later speech fluency bear implications for understanding communication in autism. For instance, these associations challenge the common assumption (made even in diagnostic criteria) that manual modes of communication are available to autistic individuals – if simply they choose to use them. These associations also highlight a potential confound from manual-motor skills when assessing autistic cognition, receptive language, and ‘nonverbal’ social communication.